Western Referral Quiz 2

Front 1

hyperthyroidism and hypolglycemic reactions cause symptoms often indistinguishable from

Back 1

anxiety

Front 2

hypothyroidism can make a patient look and feel

Back 2

depressed

Front 3

panic disorder

Back 3

sudden severe anxiety, smothering sensation, chest pain with complete recovery

Front 4

agoraphobia

Back 4

fear of going out in public

Front 5

the pulse rate in panic disorder

Back 5

usually be normal at rest < 80bpm

Front 6

epinephrine and norepinephrine

Back 6

are hormones that act at distant sites in the body and also neurotransmitters that work at synapses in the brain. They are excitatory at all locations.

Front 7

incidence of panic disorders

Back 7

15-20%

Front 8

Schizophrenia

Back 8

non-drug induced auditory hallucination, delusions, tangential thinking

psychiatric consult is always indicated, but the degree of urgency depends upon the practitioner's best estimate of the patient's impairment and the degree of danger they represent to themselves or others.

the meds have significant side effects and many patients do not take them reliably because they don't think they need them or they don't like the side effects

Front 9

positive symptoms of schizophrenia

Back 9

hallucinations
delusions of grandeur, persecution or control
rapid and unpredictable shifts in mood
hypersensitivity to stimuli of any sort
unstable and inappropriate laughter

Front 10

negative symptoms or deficits of schizophrenia

Back 10

lack of enthusiasm
difficulty in speech
decline in overall function
social withdrawal and disruptions
deterioration of personal care and hygiene
oversleeping
dependency on others, low self-esteem

Front 11

risk factors of schizophrenia

Back 11

older father
family history
prenatal maternal bereavement, famine, and malnutrition
low socioeconomic status
alcohol and street drug use

** No food Allergy**

Front 12

co-morbidities with schizophrenia

Back 12

depression, sadness, anxiety, pessimism
left handedness

Front 13

schizophrenia generally requires:

Back 13

combines interventions including social work, behavioral, psychology, and medication.

Front 14

Major depression

Back 14

patient who feels pessimistic, hopeless, and helpless

Front 15

referral options for major depression

Back 15

options will depend upon level of risk for suicide and the patient's ability to pay for services, transportation and other factors. Psychological emergency services should immediately be contacted for patients with plans to commit suicide and who refuse to sign a "no self-harm" contract

Front 16

typical history and symptoms of major depression

Back 16

depressed patients may instead complain of decreased interest in people and activities that were formerly interesting, a sense that life is not rewarding or, in more severe cases, hoplessness and helplessness. Often, if asked if they see "light at the end of the tunnel," they will say, "No"

Front 17

Physical finding for major depression

Back 17

depressed patients may look down often, sigh, avoid eye contact, and look like the "weight of the world" is on their shoulders

Front 18

Risk factors of major depression

Back 18

sedentary lifestyle
social isolation
divorce
women have higher incidence rates than men
Irregular sleep and work habits, particularly, swing or night shift work
lifestyle with inadequate daylight exposure or sudden move from equatorial to polar latitudes

Front 19

co-morbidities of major depression

Back 19

alcohol and drug abuse
postpartum state
traumatic brain injuries or surgery
diet low in omega 3 fatty acids and low vitamin D3 levels

Front 20

other important considerations of major depression

Back 20

half of all suicide victims suffer from major depression and suicide occurs in 25% of people with chronic depression

Front 21

Manic phase of bipolar disorder

Back 21

depression followed by an episode of hyper-excitation and euphoria

one illness in the family of illnesses known as "bipolar spectrum disorders" (BSD) defined by the presence of cycling, recurrent episodes of abnormally elevated mood interspersed with episodes of depressive mood

Front 22

history and symptoms of bipolar disorder

Back 22

bipolar patients cyclically experience abnormally elevated (manic or hypomanic) episodes followed by abnormally depressed episodes that are severe enough to interfere with their normal functioning

Front 23

Mania

Back 23

characterized by feelings of irritability, euphoria or excessive expansiveness

patients in mania may be intrusive, aggressive, and intolerant of others

Front 24

incidence of bipolar disorder

Back 24

the median age of onset for bipolar disorder is 25 years of age

Front 25

Drug abuse (partial loss of control over drug use) or addiction (loss of control over drug use)

Back 25

personality change, social withdrawal, unstable relationships, evasiveness and decreased academic performance in an adolescent or adult

Front 26

number of Americans with fatty livers

Back 26

1/3 or 1 out of 3

Front 27

history and symptoms of drug abuse

Back 27

in adults, the personality change and problems functioning are generally noticed by employers and coworkers. Hiding of substances, evasion and disharmony is common among spouses.

Front 28

physical exam finding of drug abuse

Back 28

adolescents and young adults can express paranoid thinking, ideas of victimhood, unrealistic fantasies, grandiosity, and melodramatic language.

Front 29

Young adults who smoked marijuana regularly:

Back 29

starting around 15 years of age, were twice as likely to develop psychosis and four times as likely to have delusional thinking in a "dose response" relationship than those who did not.

Front 30

Marijuana can produce:

Back 30

Antimotivational syndrome=
spend significantly less time in productive activities and more time in recreating

Front 31

Drug addiction does or does not change main structure of brain?

Back 31

Addiction permanently affects the structure and function of the brain. Can cause changes in the dopaminergic mesolimbic system that results in loss of control over the use of the addictive substance. Changes are mediated by a number of neurotransmitters.

Front 32

When patients use opiates, the effect on the neuron is to dampen down neuronal transmission + pain relief. Habitual usage cause glial cells to:

Back 32

respond by producing inflammatory products that they send to the neuron in an effort to wake it up.
When a person stops taking the opiates, the normal neuronal activity picks up again AND the neuron is hyper-excited because the glial cells continue their stimulatory efforts, sometimes for months

Front 33

Palpitations that are absent with exercise and present at rest are almost always:

Back 33

Benign palpitations

Front 34

Palpitations that occur reliably with exercise and go away with rest=

Back 34

RED FLAG for some type of heart disease

Front 35

Chest pain that occurs reliably with exercise and goes away with rest = red flag for

Back 35

coronary artery disease

Front 36

Tachycardia is the most reliable sign of

Back 36

hyperthyroidism, the rate >100 bpm

Front 37

Tachycardia with fever are the most reliable signs of:

Back 37

thyroid storms

Thyroid storms can lead to heart failure and death

Front 38

Rate of symptoms of hyperthyroidism:

Back 38

Increase so gradually that patients may have mild to moderate symptoms for weeks or even months before suspecting a problem

Front 39

Hyperthyroid Patients often complain of:


Family members often complain of:

Back 39

Trembling hands and a pounding or irregular heartbeat (palpitations)

mood swings and irritability (emotional lability). Hypervigilance (from fast thinking) is usually interpreted anxiety.

Front 40

Other signs of hyperthyroidism:

Back 40

Patients feel hotter than others
Heat intolerance
Warm, moist skin and easy perspiration
mild diarrhea
light or skipped menses
often fatigued at the end of the day
trouble falling asleep
weight loss despite eating more

Severe hyperthyroidism: short of breath, chest pains, muscle weakness

Front 41

Hyperthyroidism in the elderly

Back 41

Often, typical symptoms of hyperthyroidism may be missing

May complain of weight loss, fatigue, depression and/or anxiety

Front 42

More about Thyroid storm

Back 42

same symptoms as in hyperthyroidism, but heightened and with addition of fever and tremor.
Temp may be above 105.5 degrees and accompanied by nausea, vomiting, diarrhea, dehydration, delirium, and eventually coma.

Front 43

Apathetic Storm in elderly

Back 43

characterized by extreme weakness
emotional apathy
confusion rather than delirium and agitation
fever may be minimal

(appears as hypothyroid, but is hyperthyroid)

Front 44

Death rate from thyroid storms

Back 44

20%

Front 45

Prevalence of hyperthyroidism and thyroid storm:

Back 45

More common in women than men

Front 46

Risk factors for hyperthyroid storms

Back 46

Infections, esp. lung pts w/hyperthyroidism
stopping medication (to suppress hyperthyroidism)
excessive dose of thyroid hormones
pregnancy
heart attacks
other autoimmune diseases

Front 47

TIA/Transient ischemic attack:

Back 47

Fifteen minute episode of unilateral tingling/numbness that resolves completely

Front 48

TIA-definition

Back 48

Acute episode
temporary neurologic dysfunction
caused by ischemia (tissue threat w/out permanent damage)
due to: vascular occlusion w/symptoms lasting less than one hour

Front 49

Consequence of TIA

Back 49

20% of patients w/new TIA will later have a disabling or fatal stroke later

4-5% risk of stroke within 2 days of TIA
11% risk of stroke within 7 days following TIA

Front 50

If a pt is having a TIA:

Back 50

Immediately transport (or 911 transport) to ED
Urgent b/c it is impossible to say if person will recover or progress to a stroke

with cardiopulmonary instability, 911 should be called

Front 51

with a resolved TIA;

Back 51

same day, semi-urgent consultation with PCP or neurologist

May be sent to ED if no consultant can see them within the same day

Front 52

Test for TIA

Back 52

OMIT

O = ORIENTATION to person, place and time

M = checking MEMORY function

I = checking INTELLIGENCE function

T = checking TALKING function

also: standard check on cranial nerves, sensation, muscle strength, reflexes, balance and special tests (in spinal cord injury section)

Check carotids and heart because carotid bruit may be present or heart arrhythmia or murmurs may indicate valvular damage

Front 53

Per Drew...and TIA

Back 53

If someone has a TIA, within 2 - 7 days they could get another one and die

Front 54

Stabilization of TIA condition:

Back 54

If you see a pt during the symptoms of TIA, have them lay down quietly and refer for consultation or to the ED

If they are between neurological symptoms, advise them to take one baby aspirin per day until consult is accomplished. (prevention for possible strok)

Front 55

Risk factors for TIAs:

Back 55

HBP
CAD
PVD
cigarette smoking
physical inactivity
diabetes
diet high in animal fat and salt (in salt sensitive pts)
Low HDL, high LDL, high TG, high homeocysteine levels, high C-reactive protein
obesity
too much alcohol intake
use of cocaine and other drugs
birth control pills should be avoided if obesity, diabetes or hbp exist

Front 56

Multiple sclerosis

Back 56

Slow onset of patchy numbness and weakness >1 body area

Most common of several autoimmune demyelinating disease in the brain and spinal cord

Front 57

No cure for MS, but

Back 57

can be managed and early referral is required because MS is a slow progressing disease.
Left untreated, can result in disability or death

Front 58

Symptoms of MS

Back 58

-paresthesias and/or areas of patchy numbness in one or more extremities, trunk or face
-weakness or clumsiness of a leg or hand
-numbness is patchy, often skipping over dermatomes (can come and go within few days to a few weeks)
-double vision
-skin tingling and skeletal muscle weakness
-feeling of slight stiffness of a limb
-minor gait disturbances
-bladder fxn difficulty
-skeletal muscle weakness
-vertigo
-fatigue
-muscle spasticity in some areas, flaccidity in others
warm weather or hot bath may exacerbate sx
-in some cases, mild cognitive impairment
-apathy
-poor judgement
-emotion liability or depression

Front 59

Risk factors

Back 59

Family history of MS

cooler climates (highest incidences in northern Europe, northern US, southern Australia and New Zealand)

Front 60

MS Onset

Back 60

usually between 20 - 40 years old
More common in women

Front 61

Tests for MS

Back 61

* Romberg's signs (feet together, eyes closed)
* Babinski reflex (bottom of the foot test)
* gait and coordination test...heel to heel, toe to toe, repeatedly and rapidly touching finger to nose

* standard vision test--high incidence of optic neuritis
*vibration and position sense of toes

Front 62

quantitative

Back 62

timing abnormalities of the pulse

Front 63

qualitative

Back 63

how the pulse feels

Front 64

Halter Monitor

Back 64

24 hour monitoring of the heartbeat
can reveal normal heart rhythm when a patient reports significant palpitations

Front 65

Atrial Fibrillation

Back 65

fluttering of the heart chamber that contains the natural pacemaker of the heart, the SA node.

Irregularly irregular pulse with rate >100 bpm

Front 66

referral options for A-fib

Back 66

911 should be contacted for patients with:

severe shortness of breath
chest pain
lightheadedness
weakness
more rapid heartbeat (> 120 for example)

this red flag is an example of an irregularly irregular pulse, a pulse that is completely unpredictable and has no discernible pattern.

Front 67

History and symptoms of A-fib

Back 67

many patients have no symptoms

the most common symptom in people with intermittent A-fib is palpitations

**NO stimulating herbs **

Front 68

physical finding of A-fib

Back 68

stable patients may exhibit no signs except irregularly irregular pulse

Front 69

incidence and prevalence of A-fib

Back 69

most common arrhythmia, affecting about 1% of the population, mostly older than 50

1.5% aged 50-59

30% aged 80-89

Front 70

risk factors of A-fib

Back 70

previous heart disease like CAD
valvular heart disease
cardiomyopathy
sinus node disease
pericarditis
high blood pressure, especially uncontrolled
blood thinners


**make sure they have enough Mg **

Front 71

red flag for A-fib

Back 71

the atria may contract at a rate of 400-600 per minute

Front 72

Important considerations in A-fib

Back 72

most people with chronic or recurrent A-fib take warfarin (Coumadin) to lower the risk of stroke

Front 73

What is a holter monitor used for?

Back 73

a portable device for continuously monitoring various electrical activity of the cardiovascular system for at least 24 hours (often for two weeks at a time).

Front 74

Schizophrenia

Back 74

have a social worker
behavior psychologist
medication

Front 75

Stable angina =

Back 75

chest pain only w/ extreme physical exertion-can refer same day PCP.

Front 76

UNStable angina =

Back 76

chest pain w/ minimal exertion (but no current pain = ref to ER. Pt should not drive.